Monday, January 30, 2017

60% Say The Government Is Responsible for Health Coverage


Pew Research recently released results of a survey on governmental responsibility for health coverage. Here are some key findings from the report:

60% of Americans say the government should be responsible for health coverage.
The share saying it is the government's responsibility increased from 51% in 2015.
85% of Democrats say the government should be responsible for health coverage.
32% of Republicans say the government should be responsible for coverage.
3 in 4 with incomes >$30,000/year say the government should ensure coverage.  
53% of those with incomes of $75,000+ say the goverment is responsbile.


Source: Pew Research, January 13, 2017

Birth Defects Account for 5.2% of Hospital Costs


The CDC recently released an analysis of the hospitalization costs associated with birth defects. Here are some key findings from the report:

Structural or genetic birth defects affect 3% of live births in the U.S.
20% of infant deaths in the U.S. are due to birth defects.
Birth defects accounted for 3% of all hospitalizations.
5.2% of total hospital costs are attributable to birth defects.
Birth defect–associated hospitalizations cost $22.9 billion in 2013.
Cardiovascular defects accounted for 14% of birth defect hospitalizations.


Saturday, January 28, 2017

Republican ACA Proposal Poses Challenges for Multistate Employers


Kate McGovern Tornone Wednesday - January 25, 2017

A group of republican senators proposed a replacement bill for the Affordable Care Act (ACA) that would allow states to choose whether or not to keep Obamacare’s provisions in place. Because employers’ requirements would depend on where employees work, compliance could be a real challenge for companies with operations in multiple states, according to the Society for Human Resource Management (SHRM).

The bill was seemingly an attempt to gain bipartisan support but lawmakers on both sides have expressed dissatisfaction with the provisions, said Chatrane Birbal, SHRM’s senior advisor for government relations.

Sen. Bill Cassidy (R-LA), the bill’s main sponsor, assured lawmakers that this is the best option while introducing the legislation on January 23. “It has been a Republican principle that power is best held by individuals and states, not the federal government,” and this is the best way to achieve President Trump’s goals of affordable access to coverage, including for those with pre-existing health conditions, Cassidy said.

The Senate minority leader, however, disagreed. The proposal would create chaos, not affordable health care, Sen. Chuck Schumer (D-NY) told lawmakers.

What it Does

The Patient Freedom Act of 2017 (S. 191) would afford states three options: (1) keep Obamacare; (2) adopt a new option for states that is spelled out in the bill; or (3) design their own, alternative solution.

Under “option 2” a state would participate in a new market-based system and receive funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion, according to a fact sheet accompanying the bill.

States could choose to receive funds in the form of per beneficiary grants or refundable tax credits. In either case, funds will be deposited in individuals’ “Roth health savings accounts (HSAs),” a new form of account that differs from a traditional HSA in that deposits are taxable.

For states that choose option 2, individuals can be automatically enrolled in default health coverage and Roth HSAs, with the right to opt out. That will keep premium prices down, Cassidy said.

Under this bill, employers’ responsibilities will be contingent on where their employees work. If an employer only has workers in “option 2” states, it will no longer have to offer health insurance to at least 95% of its full-time workforce or face a fine, or comply with the ACA’s reporting requirements. However, if it has employees in “option 1” states, the ACA requirements remain.

This could be problematic for multistate employers, especially for those with self-insured plans according to Birbal. Those plans are regulated by the Employee Retirement Income Security Act (ERISA) and are not subject to state insurance regulations; but this bill doesn’t seem to recognize ERISA preemption, she told BLR®.

ERISA has provided employers with a workable framework for employee benefits, allowing them to offer a uniform set of benefits to employees, Birbal said. “SHRM believes that the flexibility and certainty of the ERISA framework has been essential to the success of the employer-based system and should be maintained.”

The bill leaves intact other parts of the ACA in all states, such as market reforms like the ban on pre-existing condition exclusions and the requirement to cover dependent children through age 26.

Also remaining in place is employers’ responsibility to provide breaks and spaces for nursing mothers to express breast milk. The ACA amended the Fair Labor Standards Act to require such breaks and the proposed bill doesn’t undo that amendment.

Overall, this was a good first attempt by lawmakers to meet in the middle ground, Birbal said, “but I suspect … in the coming months, we’re going to see a number of bills that are going to be introduced.”

SHRM made several requests in a letter to Congress earlier this month, including a call to maintain the flexibility afforded by ERISA. Birbal said that letter still represents the organization’s priorities. (For more information on SHRM’s requests, see Trump Takes Aim at ACA on First Day in Office.)

As for the individual mandate, Cassidy said his bill will allow fans of Obamacare to stay with it. “Republicans think that if you like your insurance, you should keep it,” he said. “California and New York: you love Obamacare; you can keep it.”

But the Center for American Progress, a liberal think tank, said his statement was disingenuous. “If you happen to live in a state controlled by those who oppose Obamacare, they would be able to gut your coverage,” the organization’s vice president for health policy, Topher Spiro, said in a statement. “It’s unconscionable that access to quality health care would depend on where you happen to live.”

Sens. Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Johnny Isakson (R-GA) also sponsored the bill. If passed, it would take effect January 1, 2018. Cassidy said that Rep. Pete Sessions (R-TX) is expected to introduce a companion bill in the House.


Kate McGovern Tornone is an editor at BLR. She has almost 10 years’ experience covering a variety of employment law topics and currently writes for HR Daily Advisor and HR.BLR.com. Before coming to BLR, she served as editor of Thompson Information Services’ ADA and FLSA publications, co-authored the Guide to the ADA Amendments Act, and published several special reports. She graduated from The Catholic University of America in Washington, D.C., with a B.A. in media studies.

Math geniuses size up 5 ACA change ideas


An American Academy of Actuaries panel analyzes a handful of popular health-law proposals

Jan 25, 2017 | By Allison Bell

The actuarial academy had its Individual and Small Group Markets Committee talk about the pros and cons of increased subsidies, risk pools and other efforts to make the ACA work better. (Photo: Getty Images)

Some Affordable Care Act change proposals that sound good on paper might jack up claims, chase customers away, or cause other unexpected problems.

In short, health insurance policy is complicated.

Members of the Individual and Small Group Markets Committee, an arm of the Washington-based American Academy of Actuaries, make that point in a look at many popular ideas for improving the ACA system.

The actuaries at the academy are people who have taken exams showing they understand statistics and risk analysis.

The academy is a professional association that tries to give policymakers and the public objective advice regarding risk and financial security issues.

The academy's Individual and Small Group Markets Committee prepared the new ACA report to help readers, including insurance agents and brokers, understand what possible alternatives to the current ACA rules might do to the commercial health insurance market.

Here's a look at some of what the committee said about five commonly discussed ACA change ideas. 

1. Spend more government money on subsidies.

Increasing subsidy amounts might be expensive for the government, but it could greatly improve the quality of the commercial health insurance risk pool by cutting healthy people's out-of-pocket premium costs and making the idea of buying health coverage more attractive, the actuaries say.

"The impact of any changes in subsidies on enrollment, premiums, and government spending would depend on the details," the actuaries say.

One problem with the current subsidy program is that net coverage costs are higher for healthy older adults as well as older adults with known health problems, the actuaries say.

"Enrolling low-cost individuals of all ages should be the goal," the actuaries say.

2. Shorten the open enrollment period.

The individual major medical open enrollment period, or time when people can now buy health coverage without showing they have what the government thinks of as a good excuse to buy health coverage, now runs from Nov. 1 through Jan. 31.

Insurers, regulators and ACA public exchange managers developed the open enrollment period system to discourage healthy consumers from waiting until they know they will be sick to pay for coverage.

Simply ending open enrollment on Dec. 31 would help health insurers by giving them a better idea of who their enrollees will be in the coming calendar year, the actuaries say.

Shortening the open enrollment period would also further reduce opportunities for consumers to wait until they get sick to pay for coverage, the actuaries say.

3. Add barer-bones 'copper' level plans.

Current ACA rules let insurers sell major medical plans in four levels of benefits richness, ranging from bronze to platinum.

Young consumers and consumers who do not qualify for subsidies can buy a fifth type of coverage, catastrophic coverage.

Some ACA watchers have argued that regulators should let insurers sell catastrophic coverage or another type of plan, bare-bones "copper" coverage, to all consumers. This could help consumers who feel that even a bronze plan is unaffordable.

Adding copper plans could increase plan sales to healthy people. But since the premiums for the plans would be lower, the copper plans would hurt the risk profile of the richer plans, the actuaries say.

The copper plans or catastrophic plans would also have high cost-sharing requirements, and, in practice, many consumers would have a hard time handling the out-of-pocket costs, the actuaries warn.

4. Let insurers widen the gap between what the youngest and oldest enrollees pay.

Today, the ACA lets an insurer charge its oldest enrollees only three times as much as they charge the youngest adult enrollees.

Some want to let insurers charge the oldest enrollees five times as much.

Widening the allowable age variation "would more closely align premiums to underlying costs by age," the actuaries say.

One study showed a plan that would cut premiums 22 percent for 21-year-olds.

But the same study showed that approach would increase premiums by 29 percent for 54-year-olds, "likely reducing older adult enrollment, while also increasing federal costs for premium subsidies due to the higher premiums," the actuaries say.

In that scenario, older adults who cannot qualify for subsidies might drop their coverage, the actuaries say.

The actuaries say widening age variations could increase ACA subsidy costs by $11 billion in 2018, if other current program rules stay in effect.

5. Set up high-risk pools for people with health problems.

Some Republicans and insurers have talked about the possibility of bringing back high-risk pools, or special subsidized health insurance programs for people with serious health problems such as cancer, heart disease or Type 1 diabetes.

In the past, when states set up risk pools, "enrollment has generally been low, coverage has been limited and expensive, they require external funding, and they have typically operated at a loss," the actuaries say.

The government has to provide substantial funding to make any new risk pools sustainable, the actuaries say.

Over time, the actuaries say, the benefits of putting high-risk people in risk pools shrink, as the health of high-risk people and other people becomes more similar, and that would put upward pressure on premiums, the actuaries say.

Another, comparable approach might be to take the money that could be used to subsidize risk pools and instead give the money to ordinary health insurers that happen to cover high-risk people, the actuaries say.
http://www.lifehealthpro.com/2017/01/25/math-geniuses-size-up-5-aca-change-ideas?eNL=5889fcdc140ba05c7c843fc8&utm_source=LHPro_NewsFlash&utm_medium=EMC-Email_editorial&utm_campaign=01262017    

Thursday, January 19, 2017

New Participants Join Several CMS Alternative Payment Models


CMS NEWS


FOR IMMEDIATE RELEASE
January 18, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

 

New Participants Join Several CMS Alternative Payment Models
Numbers demonstrate provider commitment to a health care system with better care, healthier people, and smarter spending

Today, the Centers for Medicare & Medicaid Services (CMS) announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017. Clinicians who participate in APMs are paid for the quality of care they give to their patients. APMs are an important part of the Administration’s effort to build a system that delivers better care and one in which clinicians work together to have a full understanding of patients’ needs. APMs also strive to ensure that patients are in the center of their care, and that Medicare pays for what works and spends taxpayer money more wisely resulting in a healthier country.

“By listening to physicians and engaging them as partners, CMS has been able to develop innovative payment reforms that bring physicians back to the core practice of medicine – caring for the patient,” said Acting Administrator Andy Slavitt. “By reducing regulatory burden and paying for quality, CMS is offering solutions that improve the quality of services our beneficiaries receive and reduce costs, to help ensure the Medicare program is sustainable for generations to come.”

The Medicare Shared Savings Program (Shared Savings Program), Next Generation Accountable Care Organization (ACO) Model, Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model all apply the concept of paying for quality and effectiveness of care given to patients in different health care settings. Today, CMS is announcing the participants in each of these models for the 2017 calendar year.  

 

With today’s announcement, participants in the four APMs are improving care delivery in 50 states, the District of Columbia, and Puerto Rico. In 2017, there are:

  • Over 359,000 clinicians participating in APMs
  • More than 12.3 million Medicare and/or Medicaid beneficiaries served
  • 572 ACOs across the Shared Savings Program, Next Generation ACO Model and CEC Model
  • 131 ACOs in a risk-bearing track, including in the Shared Savings Program, Next Generation ACO Model and CEC Model
  • 2,893 primary care practices participating in CPC+

The Shared Savings Program was established by Section 3022 of the Affordable Care Act and is a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act. Shared Savings Program ACOs are groups of doctors and other health care providers who voluntarily work together with Medicare to provide high quality services to Medicare fee-for-service beneficiaries. In 2017, the Shared Savings Program welcomed 99 new participants and 79 renewing participants, bringing the total number of participants to 480 across 50 states, the District of Columbia, and Puerto Rico. CMS also recently announced a new Medicare ACO Track 1+ Model for 2018 that will test a payment design that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program in order to encourage more practices, especially small practices and small rural hospitals, to advance to performance-based risk.

The Center for Medicare and Medicaid Innovation’s (Innovation Center) Next Generation ACO Model was designed to test whether strong financial incentives for ACOs can improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries. Provider groups in this model assume higher levels of financial risk and reward than are available under the Shared Savings Program. In 2017, 28 new participants have joined the model, making the total number of 2017 participants 45. CMS also recently announced a new opportunity for participation in the Next Generation ACO Model beginning in 2018. A Request for Applications (RFA) soliciting 2018 Next Generation ACO Model applications will be posted today.

The Innovation Center’s CEC Model is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with ESRD. In the CEC Model, dialysis clinics, nephrologists and other providers join together to create an ESRD Seamless Care Organization (ESCO) to coordinate care for matched beneficiaries. The CEC Model received 24 new participants for a total of 47 participants in 2017.

CPC+, also an Innovation Center model, is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ seeks to improve the quality of care beneficiaries receive, improve beneficiaries’ health, and spend health care dollars more wisely. In CPC+ Round 1, CMS is partnering with 54 payers in 14 regions with 2,893 primary care practices which include over 13,000 clinicians, in 2017. CMS also recently announced CPC+ Round 2, with participation beginning in 2018.

“These models demonstrate CMS’s commitment to partner with providers to improve care for patients,” said Dr. Patrick Conway, Acting Principal Deputy Administrator and Director of the CMS Innovation Center. “My mother and over 12 million other Medicare beneficiaries are now cared for by doctors and other clinicians in payment models that focus on better health outcomes and coordinated, high quality care.”

These initiatives and programs, developed by CMS and the Innovation Center, aim to achieve better care for patients, better health for our communities, and lower costs through improvement to our health care system. CMS expects that by the 2018 performance year, 25 percent of clinicians in the Quality Payment Program will be participating in an Advanced APM and eligible to earn APM incentive payments.

Today’s announcement describes a series of CMS initiatives that offer opportunities for clinicians to participate in Advanced Alternative Payment Models under The Medicare Access and CHIP Reauthorization ACT of 2015 (MACRA). CMS’s work in developing and expanding new payment models through the Innovation Center is guided by the following core principles:
·         Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs.
·         Engaging with and listening to consumers, health care providers, and other stakeholders allowing for open and transparent dialogue, including through the appropriate use of notice-and-comment rulemaking and ombudsmen.
·         Evaluating results based on appropriately scoped and sized model tests and advancing best practices based on their impact on health care quality and cost. 
We look forward to continuing to work with diverse stakeholders to achieve better care for patients, better health for our communities, and lower costs through improvement for our health care system.

For more information, visit the following fact sheets:

Next Generation ACO: https://innovation.cms.gov/Files/fact-sheet/nextgenaco-fs.pdf Shared Savings Program: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprog/Downloads/2017-MSP-Fact-Sheet.pdf CEC: https://innovation.cms.gov/Files/fact-sheet/cec-fs.pdf CPC+: https://innovation.cms.gov/Files/fact-sheet/cpcplus-fs-rd1.pdf

Biweekly Enrollment Snapshot


FOR IMMEDIATE RELEASE
January 18, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

 

 

Biweekly Enrollment Snapshot


WEEKS 10 AND 11, JAN 1 – JAN 14, 2017

More than 8.8 million Americans were signed up for 2017 coverage through HealthCare.gov as of January 14, 2017. This compares to about 8.7 million sign-ups as of January 14 last year, as Americans continue to demonstrate strong demand for 2017 Marketplace coverage.

“With almost 9 million people signed up for 2017 coverage just in HealthCare.gov states, it’s clear that Marketplace coverage is a product Americans want and need,” said Secretary Sylvia M. Burwell. “Strong demand is especially striking in light of the unique headwinds created by discouraging rhetoric from ACA opponents. More than 40,000 people have contacted our call center expressing concerns about whether they should sign up for coverage, with a sharp uptick in these questions last weekend. My answer is a resounding yes: in fact, I’ll be signing up for Marketplace coverage myself by the end of the month. If you still need coverage for 2017, visit HealthCare.gov or your state Marketplace before January 31, and join me and millions of other Americans in purchasing affordable, quality coverage.”

Today’s report covers the period from January 1 through January 14, 2017. Enrollment weeks are measured Sunday through Saturday. Since this year Open Enrollment began on a Tuesday, the totals reported in this snapshot reflect two fewer days than in last year’s published Week 11 snapshot. Measured over the equivalent time period, plan selections this year are almost 100,000 higher than last year.

This snapshot does not include plan selections from the 12 State-Based Marketplaces that use their own enrollment platforms (2.8 million people in these states were signed up for coverage as of December 24, 2016).  

Open Enrollment continues through January 31st. Last year, enrollment slowed in the middle of January but spiked in the days before the final deadline. Plan selection totals will also fluctuate over the remainder of Open Enrollment as some consumers choose to cancel their plans, for example in response to life changes like starting a new job with employer coverage or gaining eligibility for Medicare or Medicaid.

Every two weeks during Open Enrollment, the Centers for Medicare and Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Marketplaces and State Partnership Marketplaces, as well as some State-based Marketplaces. 

The next snapshot will be released on February 3, and will cover enrollments through the final Open Enrollment deadline; and the detailed final enrollment report will be released the week of March 13th.

These snapshots provide point-in-time estimates of biweekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov. The final number of plan selections associated with enrollment activity during a reporting period may change as plan modifications or cancellations occur, such as due to life changes like starting a new job or getting married. In addition, as in previous years, the biweekly snapshot does not report the number of consumers who have paid premiums to effectuate their enrollment.

Definitions and details on the data are included in the glossary.

Federal Marketplace Snapshot

Federal Marketplace Snapshot
Weeks 10 and 11
Jan 1 – Jan 14
Cumulative
Nov 1 – Jan 14
Plan Selections (net)
63,190
8,825,545
Consumers on Applications Submitted
440,402
11,459,784
Call Center Volume
 1,362,484
10,182,467
Calls with Spanish Speaking Representative
102,443
640,643
HealthCare.gov Users
3,990,879
22,886,641
CuidadoDeSalud.gov Users
137,483
784,854
Window Shopping HealthCare.gov Users
299,995
3,848,572
Window Shopping CuidadoDeSalud.gov Users
5,387
62,334

 

HealthCare.gov State-by-State Snapshot

Consumers across the country continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visiting HealthCare.gov or CuidadoDeSalud.gov. Individual plan selections for the states using the HealthCare.gov platform include:

 

Week 11
Cumulative Plan Selections
Nov 1 – Jan 14
Alabama
168,469
Alaska
18,255
Arizona
185,497
Arkansas
66,350
Delaware
26,879
Florida
1,668,180
Georgia
480,859
Hawaii
17,775
Illinois
353,394
Indiana
168,999
Iowa
52,178
Kansas
96,304
Kentucky
74,356
Louisiana
139,495
Maine
77,245
Michigan
309,780
Mississippi
80,491
Missouri
244,593
Montana
52,345
Nebraska
86,711
Nevada
86,152
New Hampshire
51,148
New Jersey
277,132
New Mexico
51,442
North Carolina
540,527
North Dakota
21,192
Ohio
230,925
Oklahoma
143,174
Oregon
150,426
Pennsylvania
413,183
South Carolina
217,101
South Dakota
28,499
Tennessee
221,323
Texas
1,144,864
Utah
188,905
Virginia
399,084
West Virginia
33,009
Wisconsin
235,444
Wyoming
23,860

HealthCare.gov Local Area Snapshot

The Week 11 snapshot includes a look at plan selection by Designated Market Areas (DMAs) which are local media markets. This data provides another level of detail to better understand total plan selections within local communities. Some DMAs include one or more counties in a state that is not using the HealthCare.gov platform for 2017. Plan selections for those DMAs only include data for the portion of the DMA that is using the HealthCare.gov platform, so the amounts reported in the snapshot do not represent plan selections for the entire DMA. However, in cases where a DMA includes portions of multiple states but all of those states use the HealthCare.gov platform, the reported amounts reflect the whole DMA. 

Local Markets in HealthCare.gov States
State
Cumulative Plan Selections Nov 1 – Jan 14
Abilene-Sweetwater
Texas
9,272
Albany
Georgia
12,417
Albuquerque-Santa Fe
New Mexico
42,625
Alexandria
Louisiana
5,124
Alpena
Michigan
1,376
Amarillo
Texas
13,625
Anchorage
Alaska
11,796
Atlanta
Georgia
364,899
Augusta
Georgia
24,998
Austin
Texas
108,703
Bangor
Maine
20,560
Baton Rouge
Louisiana
27,909
Beaumont-Port Arthur
Texas
14,073
Bend
Oregon
9,277
Billings
Montana
11,995
Biloxi-Gulfport
Mississippi
7,920
Birmingham (Ann and Tusc)
Alabama
62,267
Bluefield-Beckley-Oak Hill
West Virginia
6,375
Boise
Idaho
820
Boston (Manchester)
Massachusetts
40,992
Bowling Green
Kentucky
4,786
Buffalo
New York
1,290
Burlington-Plattsburgh
Vermont
5,027
Butte-Bozeman
Montana
10,878
Casper-Riverton
Wyoming
5,253
Cedar Rapids-Wtrlo-IWC & Dub
Iowa
14,567
Champaign & Sprngfld-Decatur
Illinois
22,489
Charleston
South Carolina
41,529
Charleston-Huntington
West Virginia
17,114
Charlotte
North Carolina
182,822
Charlottesville
Virginia
10,571
Chattanooga
Tennessee
32,886
Cheyenne-Scottsbluf
Wyoming
5,531
Chicago, IL
Illinois
278,058
Cincinnati, OH
Ohio
48,104
Clarksburg-Weston
West Virginia
4,651
Cleveland-Akron (Canton)
Ohio
76,381
Columbia
South Carolina
42,354
Columbia-Jefferson City
Missouri
15,515
Columbus
Georgia
17,160
Columbus
Ohio
51,456
Columbus-Tupelo-West Point
Mississippi
11,203
Corpus Christi
Texas
19,640
Dallas-Ft. Worth
Texas
322,710
Davenport-R. Island-Moline
Iowa/Illinois
16,186
Dayton
Ohio
21,614
Denver
Colorado
8,276
Des Moines-Ames
Iowa
19,461
Detroit
Michigan
156,182
Dothan
Alabama
7,627
Duluth-Superior
Minnesota
5,390
El Paso (Las Cruces)
Texas
55,248
Elmira (Corning)
New York
1,223
Erie
Pennsylvania
9,372
Eugene
Oregon
20,671
Evansville
Indiana
16,800
Fairbanks
Alaska
1,872
Fargo-Valley City
North Dakota
10,613
Flint-Saginaw-Bay City
Michigan
29,475
Ft. Myers-Naples
Florida
95,149
Ft. Smith-Fay-Sprngdl-Rgrs
Arkansas
21,924
Ft. Wayne
Indiana
19,418
Gainesville
Florida
18,031
Glendive
Montana
502
Grand Rapids-Kalmzoo-B.Crk
Michigan
58,931
Great Falls
Montana
7,200
Green Bay-Appleton
Wisconsin
49,633
Greensboro-H.Point-W.Salem
North Carolina
93,166
Greenville-N.Bern-Washngtn
North Carolina
37,616
Greenvll-Spart-Ashevll-And
North Carolina
113,392
Greenwood-Greenville
Mississippi
4,891
Harlingen-Wslco-Brnsvl-Mca
Texas
51,284
Harrisburg-Lncstr-Leb-York
Pennsylvania
57,028
Harrisonburg
Virginia
11,089
Hattiesburg-Laurel
Mississippi
9,194
Helena
Montana
2,685
Honolulu
Hawaii
17,771
Houston
Texas
335,490
Huntsville-Decatur
Alabama
38,812
Idaho Falls-Pocatello
Idaho
2,315
Indianapolis
Indiana
78,610
Jackson
Mississippi
27,688
Jackson
Tennessee
8,417
Jacksonville
Florida
95,628
Johnstown-Altoona
Pennsylvania
18,783
Jonesboro
Arkansas
4,630
Joplin-Pittsburg
Missouri
12,786
Juneau
Alaska
813
Kansas City
Kansas/Missouri
94,929
Knoxville
Tennessee
47,594
La Crosse-Eau Claire
Wisconsin
19,348
Lafayette
Indiana
3,869
Lafayette
Louisiana
17,765
Lake Charles
Louisiana
5,108
Lansing
Michigan
16,948
Laredo
Texas
13,638
Las Vegas
Nevada
63,018
Lexington
Kentucky
20,862
Lima
Ohio
2,696
Lincoln & Hastings-Krny
Nebraska
38,036
Little Rock-Pine Bluff
Arkansas
32,333
Louisville
Kentucky
32,432
Lubbock
Texas
12,737
Macon
Georgia
20,653
Madison
Wisconsin
35,942
Marquette
Michigan
8,827
Medford-Klamath Falls
Oregon
14,289
Memphis
Tennessee
50,999
Meridian
Mississippi
4,388
Miami-Ft. Lauderdale
Florida
605,012
Milwaukee
Wisconsin
91,483
Minneapolis-St. Paul
Minnesota
12,549
Minot-Bismarck-Dickinson
North Dakota
12,105
Missoula
Montana
17,424
Mobile-Pensacola (Ft Walt)
Alabama
61,606
Monroe-El Dorado
Louisiana/Arkansas
11,816
Montgomery-Selma
Alabama
19,487
Myrtle Beach-Florence
Florida
42,475
Nashville
Tennessee
91,418
New Orleans
Louisiana
62,100
New York
New York
217,225
Norfolk-Portsmth-Newpt News
Virginia
74,132
North Platte
Nebraska
1,689
Odessa-Midland
Texas
11,842
Oklahoma City
Oklahoma
73,028
Omaha
Nebraska
38,324
Orlando-Daytona Bch-Melbrn
Florida
 318,394
Ottumwa-Kirksville
Missouri
3,359
Paducah-Cape Girard-Harsbg
Illinois/Kentucky/Missouri
23,840
Panama City
Florida
22,004
Parkersburg
West Virginia
3,020
Peoria-Bloomington
Illinois
14,245
Philadelphia
Pennsylvania
274,656
Phoenix (Prescott)
Arizona
148,146
Pittsburgh
Pennsylvania
79,991
Portland, OR
Oregon
99,242
Portland-Auburn
Maine
56,979
Presque Isle
Maine
4,009
Quincy-Hannibal-Keokuk
Illinois/Missouri/Iowa
7,460
Raleigh-Durham (Fayetvlle)
North Carolina
145,684
Rapid City
South Dakota
8,626
Reno
Nevada
21,942
Richmond-Petersburg
Virginia
74,567
Roanoke-Lynchburg
Virginia
52,717
Rochestr-Mason City-Austin
Minnesota/Iowa
1,719
Rockford
Illinois
13,193
Salisbury
Maryland
7,794
Salt Lake City
Utah
188,822
San Angelo
Texas
4,700
San Antonio
Texas
103,184
Savannah
Georgia
39,391
Sherman-Ada
Texas
10,138
Shreveport
Louisiana
26,304
Sioux City
Iowa
11,334
Sioux Falls(Mitchell)
South Dakota
22,026
South Bend-Elkhart
Indiana
25,271
Spokane
Washington
1,263
Springfield
Missouri
50,026
St. Joseph
Missouri
3,954
St. Louis
Missouri
120,682
Tallahassee-Thomasville
Florida
28,221
Tampa-St. Pete (Sarasota)
Florida
282,759
Terre Haute
Indiana
8,837
Toledo
Ohio
19,994
Topeka
Kansas
12,466
Traverse City-Cadillac
Michigan
25,517
Tri-Cities
Tennessee
24,937
Tucson (Sierra Vista)
Arizona
32,432
Tulsa
Oklahoma
51,438
Tyler-Longview(Lfkn&Ncgd)
Texas
27,939
Victoria
Texas
2,370
Waco-Temple-Bryan
Texas
24,385
Washington, DC (Hagerstown)
Virginia/Maryland/District of Columbia 
178,408
Wausau-Rhinelander
Wisconsin
22,224
West Palm Beach-Ft. Pierce
Florida
186,341
Wheeling-Steubenville
Ohio
6,330
Wichita Falls & Lawton
Texas
10,983
Wichita-Hutchinson Plus
Kansas
37,113
Wilkes Barre-Scranton
Pennsylvania
45,398
Wilmington
Delaware
29,562
Yakima-Pasco-Rchlnd-Knnwck
Oregon
1,769
Youngstown
Ohio
13,781
Yuma-El Centro
Arizona
2,917
Zanesville
Ohio
1,758

 

Glossary

Plan Selections:  The cumulative metric represents the total number of people who have submitted an application and selected a plan, net of any cancellations from a consumer or cancellations from an insurer that have occurred to date. The biweekly metric represents the net change in the number of non-cancelled plan sections over the two-week period covered by the report.

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not report the number of effectuated enrollments.

New Consumers: A consumer is considered to be a new consumer if they did not have Marketplace coverage at the start of Open Enrollment on November 1st, 2016.

Renewing Consumers: A consumer is considered to be a renewing consumer if they had 2016 Marketplace coverage on November 1st, 2016 at the start of Open Enrollment and either actively selected the same plan or a new plan for 2017, were automatically re-enrolled into their plan, or were signed up for January 1 coverage through a suggested alternate plan.

 Marketplace: Generally, references to the Health Insurance Marketplace in this report refer to 39 states that use the HealthCare.gov platform. The states using the HealthCare.gov platform are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 39 states with Marketplaces that use the HealthCare.gov platform for the 2017 benefit year, including those with Federally-facilitated Marketplaces, State Partnership Marketplaces, and State-based Marketplaces.

Consumers on Applications Submitted:  This includes consumers who are requesting coverage on a completed and submitted application, including an application that is created through the automatic re-enrollment process, which occurs at the end of December, in a state that is using the HealthCare.gov platform. If determined eligible for Marketplace coverage, a new consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people requesting coverage on a submitted application (rather than the total number of submitted applications).

Call Center Volume:  The total number of calls received by the call center for the 39 states that use the HealthCare.gov platform over the course of the weeks covered by the snapshot or from the start of Open Enrollment. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative:  The total number of calls received by the Federally-facilitated Marketplace call center where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

HealthCare.gov or CuidadodeSalud.gov  Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadodeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.